Association of hormone therapy and incident gout: population-based case-control study

OBJECTIVE This study aims to assess the odds of developing incident gout in association with the use of postmenopausal estrogen-progestogen therapy, according to type, timing, duration, and route of administration of estrogen-progestogen therapy. METHODS We conducted a retrospective population-based case-control analysis using the United Kingdom-based Clinical Practice Research Datalink. We identified women (aged 45 y or older) who had a first-time diagnosis of gout recorded between 1990 and 2010. We matched one female control with each case on age, general practice, calendar time, and years of active history in the database. We used multivariate conditional logistic regression to calculate odds ratios (ORs) with 95% CIs (adjusted for confounders). RESULTS The adjusted OR for gout with current use of oral formulations of opposed estrogens (estrogen-progestogen) was 0.69 (95% CI, 0.56-0.86) compared with never use. Current use was associated with a decreased OR for gout in women without renal failure (adjusted OR, 0.71; 95% CI, 0.57-0.87) and hypertension (adjusted OR, 0.62; 95% CI, 0.44-0.87) compared with never use. Tibolone was associated with a decreased OR for gout (adjusted OR, 0.77; 95% CI, 0.63-0.95) compared with never use. Estrogens alone did not alter the OR for gout. CONCLUSIONS Current use of oral opposed estrogens, but not unopposed estrogens, is associated with a decreased OR for incident gout in women without renal failure and is more pronounced in women with hypertension. Use of tibolone is associated with a decreased OR for incident gout. The decreased OR for gout may be related to the progestogen component rather than the estrogen component.

Automatic quality control in clinical (1) H MRSI of brain cancer.

MRSI grids frequently show spectra with poor quality, mainly because of the high sensitivity of MRS to field inhomogeneities. These poor quality spectra are prone to quantification and/or interpretation errors that can have a significant impact on the clinical use of spectroscopic data. Therefore, quality control of the spectra should always precede their clinical use. When performed manually, quality assessment of MRSI spectra is not only a tedious and time-consuming task, but is also affected by human subjectivity. Consequently, automatic, fast and reliable methods for spectral quality assessment are of utmost interest. In this article, we present a new random forest-based method for automatic quality assessment of (1) H MRSI brain spectra, which uses a new set of MRS signal features. The random forest classifier was trained on spectra from 40 MRSI grids that were classified as acceptable or non-acceptable by two expert spectroscopists. To account for the effects of intra-rater reliability, each spectrum was rated for quality three times by each rater. The automatic method classified these spectra with an area under the curve (AUC) of 0.976. Furthermore, in the subset of spectra containing only the cases that were classified every time in the same way by the spectroscopists, an AUC of 0.998 was obtained. Feature importance for the classification was also evaluated. Frequency domain skewness and kurtosis, as well as time domain signal-to-noise ratios (SNRs) in the ranges 50-75 ms and 75-100 ms, were the most important features. Given that the method is able to assess a whole MRSI grid faster than a spectroscopist (approximately 3 s versus approximately 3 min), and without loss of accuracy (agreement between classifier trained with just one session and any of the other labelling sessions, 89.88%; agreement between any two labelling sessions, 89.03%), the authors suggest its implementation in the clinical routine. The method presented in this article was implemented in jMRUI's SpectrIm plugin. Copyright © 2016 John Wiley & Sons, Ltd.

Buparvaquone is active against Neospora caninum in vitro and in experimentally infected mice.

The naphthoquinone buparvaquone is currently the only drug used against theileriosis. Here, the effects of buparvaquone were investigated in vitro and in an experimental mouse model for Neospora caninum infection. In 4-day proliferation assays, buparvaquone efficiently inhibited N. caninum tachyzoite replication (IC50 = 4.9 nM; IC100 = 100 nM). However, in the long term tachyzoites adapted and resumed proliferation in the presence of 100 nM buparvaquone after 20 days of cultivation. Parasiticidal activity was noted after 9 days of culture in 0.5 µM or 6 days in 1 µM buparvaquone. TEM of N. caninum infected fibroblasts treated with 1 µM buparvaquone showed that the drug acted rather slowly, and ultrastructural changes were evident only after 3-5 days of treatment, including severe alterations in the parasite cytoplasm, changes in the composition of the parasitophorous vacuole matrix and a diminished integrity of the vacuole membrane. Treatment of N. caninum infected mice with buparvaquone (100 mg/kg) either by intraperitoneal injection or gavage prevented neosporosis symptoms in 4 out of 6 mice in the intraperitoneally treated group, and in 6 out of 7 mice in the group receiving oral treatment. In the corresponding controls, all 6 mice injected intraperitoneally with corn oil alone died of acute neosporosis, and 4 out of 6 mice died in the orally treated control group. Assessment of infection intensities in the treatment groups showed that, compared to the drug treated groups, the controls showed a significantly higher parasite load in the lungs while cerebral parasite load was higher in the buparvaquone-treated groups. Thus, although buparvaquone did not eliminate the parasites infecting the CNS, the drug represents an interesting lead with the potential to eliminate, or at least diminish, fetal infection during pregnancy.

Theileria parva: taking control of host cell proliferation and survival mechanisms.

The intracellular parasite Theileria parva infects and transforms bovine T-cells, inducing their uncontrolled proliferation and spread in non-lymphoid as well as lymphoid tissues. This parasite-induced transformation is the predominant factor contributing to the pathogenesis of a lymphoproliferative disease, called East Coast fever. T. parva-transformed cells become independent of antigenic stimulation or exogenous growth factors. A dissection of the signalling pathways that are activated in T. parva-infected cells shows that the parasite bypasses signalling pathways that normally emanate from the T-cell antigen receptor to induce continuous proliferation. This review concentrates on the influence of the parasite on the state of activation of the mitogen-activated protein kinase (MAPK), NF-kappaB and phosphoinositide-3-kinase (PI3-K) pathways in the host cell. Of the MAPKs, JNK, but not ERK or p38, is active, inducing constitutive activation of the transcription factors AP-1 and ATF-2. A crucial step in the transformation process is the persistent activation of the transcription factor NF-kappaB, which protects T. parva-transformed cells from spontaneous apoptosis accompanying the transformation process. Inhibitor studies also suggest an important role for the lipid kinase, PI-3K, in the continuous proliferation of T. parva-transformed lymphocytes.

An empirical evaluation of the Random Forests classifier models for variable selection in a large-scale lung cancer case-control study

Random Forests™ is reported to be one of the most accurate classification algorithms in complex data analysis. It shows excellent performance even when most predictors are noisy and the number of variables is much larger than the number of observations. In this thesis Random Forests was applied to a large-scale lung cancer case-control study. A novel way of automatically selecting prognostic factors was proposed. Also, synthetic positive control was used to validate Random Forests method. Throughout this study we showed that Random Forests can deal with large number of weak input variables without overfitting. It can account for non-additive interactions between these input variables. Random Forests can also be used for variable selection without being adversely affected by collinearities. ^ Random Forests can deal with the large-scale data sets without rigorous data preprocessing. It has robust variable importance ranking measure. Proposed is a novel variable selection method in context of Random Forests that uses the data noise level as the cut-off value to determine the subset of the important predictors. This new approach enhanced the ability of the Random Forests algorithm to automatically identify important predictors for complex data. The cut-off value can also be adjusted based on the results of the synthetic positive control experiments. ^ When the data set had high variables to observations ratio, Random Forests complemented the established logistic regression. This study suggested that Random Forests is recommended for such high dimensionality data. One can use Random Forests to select the important variables and then use logistic regression or Random Forests itself to estimate the effect size of the predictors and to classify new observations. ^ We also found that the mean decrease of accuracy is a more reliable variable ranking measurement than mean decrease of Gini. ^

Prevalence and risk factors of methicillin-resistant Staphylococcus aureus in critically-ill hospitalized patients in a tertiary care center in Houston, Texas: An active surveillance pilot project

Objective. The objective of this study is to determine the prevalence of MRSA colonization in adult patients admitted to intensive care units at an urban tertiary care hospital in Houston, Texas and to evaluate the risk factors associated with colonization during a three month active-screening pilot project. Design. This study used secondary data from a small cross-sectional pilot project. Methods. All patients admitted to the seven specialty ICUs were screened for MRSA by nasal culture. Results were obtained utilizing the BD GeneOhm™ IDI-MRSA assay in vitro diagnostic test, for rapid MRSA detection. Statistical analysis was performed using the STATA 10, Epi Info, and JavaStat. Results . 1283/1531 (83.4%) adult ICU admissions were screened for nasal MRSA colonization. Of those screened, demographic and risk factor data was available for 1260/1283 (98.2%). Unresolved results were obtained for 73 patients. Therefore, a total of 1187/1531 (77.5%) of all ICU admissions during the three month study period are described in this analysis. Risk factors associated with colonization included the following: hospitalization within the last six months (odds ratio 2.48 [95% CI, 1.70-3.63], p=0.000), hospitalization within the last 12 months, (odds ratio 2.27 [95% CI, 1.57-3.80], p=0.000), and having diabetes mellitus (odds ratio 1.63 [95% CI, 1.14-2.32], p=0.007). Conclusion. Based on the literature, the prevalence of MRSA for this population is typical of other prevalence studies conducted in the United States and coincides with the continual increasing trend of MRSA colonization. Significant risk factors were similar to those found in previous studies. Overall, the active surveillance screening pilot project has provided valuable information on a population not widely addressed. These findings can aid in future interventions for the education, control, prevention, and treatment of MRSA. ^

Case-control study of factors associated with virologic failure in HIV-infected children on HAART in Botswana, a developing African country

According to the United Nations Program on HIV/AIDS (UNAIDS, 2008), in 2007 about 67 per cent of all HIV-infected patients in the world were in Sub-Saharan Africa, with 35% of new infections and 38% of the AIDS deaths occurring in Southern Africa. Globally, the number of children younger than 15 years of age infected with HIV increased from 1.6 million in 2001 to 2.0 million in 2007 and almost 90% of these were in Sub-Saharan Africa. (UNAIDS, 2008).^ Both clinical and laboratory monitoring of children on Highly Active Anti-Retroviral Therapy (HAART) are important and necessary to optimize outcomes. Laboratory monitoring of HIV viral load and genotype resistance testing, which are important in patient follow-up to optimize treatment success, are both generally expensive and beyond the healthcare budgets of most developing countries. This is especially true for the impoverished Sub-Saharan African nations. It is therefore important to identify those factors that are associated with virologic failure in HIV-infected Sub-Saharan African children. This will inform practitioners in these countries so that they can predict which patients are more likely to develop virologic failure and therefore target the limited laboratory monitoring budgets towards these at-risk patients. The objective of this study was to examine those factors that are associated with virologic failure in HIV-infected children taking Highly Active Anti-retroviral Therapy in Botswana, a developing Sub-Saharan African country. We examined these factors in a Case-Control study using medical records of HIV-infected children and adolescents on HAART at the Botswana-Baylor Children's Clinical Center of Excellence (BBCCCOE) in Gaborone, Botswana. Univariate and Multivariate Regression Analyses were performed to identify predictors of virologic failure in these children.^ The study population comprised of 197 cases (those with virologic failure) and 544 controls (those with virologic success) with ages ranging from 3 months to 16 years at baseline. Poor adherence (pill count <95% on at least 3 consecutive occasions) was the strongest independent predictor of virologic failure (adjusted OR = 269.97, 95% CI = 104.13 to 699.92; P < 0.001). Other independent predictors of virologic failure identified were: First Line NNRTI with Nevirapine (OR = 2.99, 95% CI = 1.19 to7.54; P = 0.020), Baseline HIV-1 Viral Load >750,000/ml (OR = 257, 95% CI = 1.47 to 8.63; P = 0.005), Positive History of PMTCT (OR = 11.65, 95% CI = 3.04-44.57; P < 0.001), Multiple Care-givers (>=3) (OR = 2.56, 95% CI = 1.06 to 6.19; P = 0.036) and Residence in a Village (OR = 2.85, 95% CI = 1.36 to 5.97; P = 0.005).^ The results of this study may help to improve virologic outcomes and reduce the costs of caring for HIV-infected children in resource-limited settings. ^ Keywords: Virologic Failure, Highly Active Anti-Retroviral Therapy, Sub-Saharan Africa, Children, Adherence.^

Ciudadanos, administración pública y control

Este trabajo responde al propósito de reflexionar acerca de las formas que toma el control de la administración pública en nuestro país, ahondando especialmente en el control social. El recorrido y análisis de diversas normas y programas, además de su cruce con las distintas modalidades del control, muestran diferentes instancias de participación que constituyen nuevos campos de intervención ciudadana. En todas y cada una de ellas, el acceso a la información pública aparece como auténtico presupuesto de la participación. Nuevos instrumentos y modalidades en los que, sin embargo, debemos resaltar el carácter de no vinculante que tienen las audiencias públicas y el escaso margen generado para la participación activa en los distintos programas. De todas maneras esos instrumentos son perfectibles y a futuro habrá de pensarse en el modo de transformar esta incipiente participación en una intervención activa y vigorosa que defina una nueva relación Estado/sociedad.

Nicotinamide nucleotide and adenylate concentrations in mante, siphon and gill tissue of old and young Laternula elliptica individuals under control and experimental conditions

Future oceans are predicted to contain less oxygen than at present. This is because oxygen is less soluble in warmer water and predicted stratification will reduce mixing. Hypoxia in marine environments is thus likely to become more widespread in marine environments and understanding species-responses is important to predicting future impacts on biodiversity. This study used a tractable model, the Antarctic clam, Laternula elliptica, which can live for 36 years, and has a well-characterized ecology and physiology to understand responses to hypoxia and how the effect varied with age. Younger animals had a higher condition index, higher adenylate energy charge and transcriptional profiling indicated that they were physically active in their response to hypoxia, whereas older animals were more sedentary, with higher levels of oxidative damage and apoptosis in the gills. These effects could be attributed, in part, to age-related tissue scaling; older animals had proportionally less contractile muscle mass and smaller gills and foot compared with younger animals, with consequential effects on the whole-animal physiological response. The data here emphasize the importance of including age effects, as large mature individuals appear to be less able to resist hypoxic conditions and this is the size range that is the major contributor to future generations. Thus, the increased prevalence of hypoxia in future oceans may have marked effects on benthic organisms' abilities to persist and this is especially so for long-lived species when predicting responses to environmental perturbation.

Soporte de redes activas para un servicio integrado de multipunto fiable con control de congestión

Las limitaciones de las tecnologías de red actuales, identificadas en la Agencia de Proyectos de Investigación Avanzados para la Defensa (DARPA) durante 1995, han originado recientemente una propuesta de modelo de red denominado Redes Activas. En este modelo, los nodos proporcionan un entorno de ejecución sobre el que se ejecuta el código asociado a cada paquete. El objetivo es disponer de una tecnología de red que permita que nuevos servicios de red sean desarrollados e instalados rápidamente sin modificar los nodos de la red. Un servicio de red que se puede beneficiar de esta tecnología es la transmisión de datos en multipunto con diferentes grados fiabilidad. Las propuestas actuales de servicios de multipunto fiable proporcionan una solución específica para cada clase de aplicaciones, y los protocolos existentes extremo a extremo sufren de limitaciones técnicas relacionadas con una fiabilidad limitada, y con la ausencia de mecanismos de control de congestión efectivos. Esta tesis realiza propuestas originales conducentes a solucionar parte de las limitaciones actuales en el ámbito de Redes Activas y multipunto fiable con control de congestión. En primer lugar, se especificará un servicio genérico de multipunto fiable que, basándose en los requisitos de una serie de aplicaciones consideradas relevantes, proporcione diferentes clases de sesiones y grados de fiabilidad. Partiendo de la definición del servicio genérico especificado, se diseñará un protocolo de comunicaciones sobre la tecnología de Redes Activas que proporcione dicho servicio. El protocolo diseñado estará dotado de un mecanismo de control de congestión para que la fuente ajuste dinámicamente el tráfico inyectado a las condiciones de carga de la red. En esta tesis se pretende también profundizar en el estudio y análisis de la tecnología de Redes Activas, experimentando con dicha tecnología para proporcionar una realimentación a sus diseñadores. Dicha experimentación se realizará en tres ámbitos: el de los servicios y protocolos que puede soportar, el del modelo y arquitectura de las Redes Activas y el de las plataformas de ejecución disponibles. Como aportación adicional de este trabajo, se validarán los objetivos anteriores mediante una implementación piloto de las entidades de protocolo y de su interfaz de servicio sobre uno de los entornos de ejecución disponibles. Abstract The limitations of current networking technologies identified in the Defense Advance Research Projects Agency (DARPA) along 1995 have led to a recent proposal of a new network model called Active Networks. In this model, the nodes provide an execution environment over which the code used to process each packet is executed. The objective is a network technology that allows the fast design and deployment of new network services without requiring the modification of the network nodes. One network service that could benefit from this technology is the transmission of multicast data with different types of loss tolerance. The current proposals for reliable multicast services provide specific solutions for each application class, and existing end-to-end protocols suffer from technical drawbacks related to limited reliability and lack of an effective congestion control mechanism. This thesis contains original proposals that aim to solve part of the current drawbacks in the scope of Active Networks and reliable multicast with congestion control. Firstly, a generic reliable multicast network service will be specified. This service will be designed from the requirements of a relevant set of applications, and will provide different session classes and different types of reliability. Then, a network protocol based on Active Network technology will be designed such that it provides the specified network service. This protocol will incorporate a congestion control mechanism capable of performing an automatic adjustment of the traffic injected by the source to the available network capacity. This thesis will also contribute to a deeper study and analysis of Active Network technology, by experimenting with the technology in order to provide feedback to its designers. This experimentation will be done attending to three different scopes: support of Active Network for services and protocols, Active Network model and architecture, and currently available Active Network execution environments. As an additional contribution of this work, the previous objectives will be validated through a prototype implementation of the protocol entities and the service interface based on one of the current execution environments.

Current Mode with RMS Voltage and Offset Control Loops for a Single-Phase Aircraft Inverter Suitable for Parallel and 3-Phase Operation Modes

Rms voltage regulation may be an attractive possibility for controlling power inverters. Combined with a Hall Effect sensor for current control, it keeps its parallel operation capability while increasing its noise immunity, which may lead to a reduction of the Total Harmonic Distortion (THD). Besides, as voltage regulation is designed in DC, a simple PI regulator can provide accurate voltage tracking. Nevertheless, this approach does not lack drawbacks. Its narrow voltage bandwidth makes transients last longer and it increases the voltage THD when feeding non-linear loads, such as rectifying stages. On the other hand, the implementation can fall into offset voltage error. Furthermore, the information of the output voltage phase is hidden for the control as well, making the synchronization of a 3-phase setup not trivial. This paper explains the concept, design and implementation of the whole control scheme, in an on board inverter able to run in parallel and within a 3-phase setup. Special attention is paid to solve the problems foreseen at implementation level: a third analog loop accounts for the offset level is added and a digital algorithm guarantees 3-phase voltage synchronization.

SMA-Based Muscle-Like Actuation in Biologically Inspired Robots: A State of the Art Review

New actuation technology in functional or "smart" materials has opened new horizons in robotics actuation systems. Materials such as piezo-electric fiber composites, electro-active polymers and shape memory alloys (SMA) are being investigated as promising alternatives to standard servomotor technology [52]. This paper focuses on the use of SMAs for building muscle-like actuators. SMAs are extremely cheap, easily available commercially and have the advantage of working at low voltages. The use of SMA provides a very interesting alternative to the mechanisms used by conventional actuators. SMAs allow to drastically reduce the size, weight and complexity of robotic systems. In fact, their large force-weight ratio, large life cycles, negligible volume, sensing capability and noise-free operation make possible the use of this technology for building a new class of actuation devices. Nonetheless, high power consumption and low bandwidth limit this technology for certain kind of applications. This presents a challenge that must be addressed from both materials and control perspectives in order to overcome these drawbacks. Here, the latter is tackled. It has been demonstrated that suitable control strategies and proper mechanical arrangements can dramatically improve on SMA performance, mostly in terms of actuation speed and limit cycles.

Combining series elastic actuation and magneto-rheological damping for the control of agile locomotion

All-terrain robot locomotion is an active topic of research. Search and rescue maneuvers and exploratory missions could benefit from robots with the abilities of real animals. However, technological barriers exist to ultimately achieving the actuation system, which is able to meet the exigent requirements of these robots. This paper describes the locomotioncontrol of a leg prototype, designed and developed to make a quadruped walk dynamically while exhibiting compliant interaction with the environment. The actuation system of the leg is based on the hybrid use of series elasticity and magneto-rheological dampers, which provide variable compliance for natural-looking motion and improved interaction with the ground. The locomotioncontrol architecture has been proposed to exploit natural leg dynamics in order to improve energy efficiency. Results show that the controller achieves a significant reduction in energy consumption during the leg swing phase thanks to the exploitation of inherent leg dynamics. Added to this, experiments with the real leg prototype show that the combined use of series elasticity and magneto-rheologicaldamping at the knee provide a 20 % reduction in the energy wasted in braking the knee during its extension in the leg stance phase.

Contribution of the noise radiated by a single vehicle to the road traffic noise

El ruido del tráfico rodado supone aproximadamente la mitad del ruido global ambiental. Las técnicas de control de ruido habitual en emisión (límites de emisión de vehículos) e inmisión (barreras acústicas, doble acristalamiento) no han sido suficientes para disminuir significativamente las molestias por el tráfico rodado en las últimas tres décadas. El efecto positivo de estas técnicas de control ha sido contrarrestado por el aumento de la densidad del tráfico. Por otra parte, la molestia del ruido del tráfico está altamente correlacionada con los niveles máximos de ruido (MNL), producidos por lo general por conductores agresivos. Sin embargo, los sistemas actuales de medición de ruido de tráfico se basan en una valoración global, por lo que no son capaces de discriminar entre los conductores silenciosos y ruidosos. Por lo tanto, en esta tesis se propone un sistema de medida de ruido en el campo cercano, que es capaz de medir la contribución de cada vehículo individual al ruido del tráfico rodado, permitiendo la detección de los conductores ruidosos. Este trabajo describe también una combinación de investigaciones analíticas y experimentales para la identificación de los conductores responsables de la generación de niveles máximos de ruido. El sistema se basa en dos micrófonos embarcados, uno para el ruido del motor y otro para el ruido de rodadura. Con el fin de relacionar estas mediciones de campo cercano con el ruido de los vehículos radiado al campo lejano, se desarrolla un procedimiento completo para la extrapolación del ruido medido por los micrófonos de campo próximo a las posiciones de campo lejano, usando una combinación de predicción analítica y mediciones experimentales. Las correcciones para los niveles extrapolados se deben a factores atmosféricos, al término de divergencia esférica y a las condiciones de absorción de la superficie de propagación. Para el micrófono situado próximo al motor, es necesario también caracterizar las propiedades acústicas del capó del motor. Ambos niveles de ruido se extrapolan de forma independiente a la posición de campo lejano, donde se realiza una comparación entre la predicción y mediciones para confirmar que la metodología es fiable para estimar el impacto a distancia del ruido de tráfico

Neural network controller for active demand side management with PV energy in the residential sector

In this paper, we describe the development of a control system for Demand-Side Management in the residential sector with Distributed Generation. The electrical system under study incorporates local PV energy generation, an electricity storage system, connection to the grid and a home automation system. The distributed control system is composed of two modules: a scheduler and a coordinator, both implemented with neural networks. The control system enhances the local energy performance, scheduling the tasks demanded by the user and maximizing the use of local generation.